Prognostic factors for mycological cure in patients with onychomycosis caused by Neoscytalidium dimidiatum: A retrospective cohort study

Abstract

Background: The prognostic factors for cure have been derived from cases of dermatophyte onychomycosis. However, there are limited studies in non-dermatophyte onychomycosis. Neoscytalidium dimidiatum is the common causative agents of non-dermatophyte onychomycosis which has proven to be recalcitrant to treatment. Objective: This retrospective cohort study investigated mycological cure and prognostic factors in Neoscytalidium onychomycosis patients. Methods: Patients aged 18 or older with newly diagnosed Neoscytalidium onychomycosis were enrolled. All patients were treated and followed up for at least 1 year. Mycological cure was analysed with Cox proportional hazard regression. The hazard ratios (HRs) of previously reported potential prognostic factors were included in univariable and multivariable stratified Cox regression analyses. Results: From total 198 patients, mycological cure was achieved in 108 (54.6%) patients with a median of 490 (± SD 62.2) days. The poor prognostic factors for mycological cure were age ≥ 70 years (HR, 0.63; 95% CI, 0.41–0.97; p =.034); nail thickness ≥2 mm (HR, 0.20; 95% CI, 0.11–0.35; p <.001); and peripheral vascular disease (HR, 0.46; 95% CI, 0.28–0.77; p =.003). Combination therapy was associated with achieving a mycological cure (HR, 2.55; 95% CI, 1.49–4.38; p <.001). Conclusions: Approximately half of the patients with onychomycosis caused by Neoscytalidium dimidiatum achieved a mycological cure, with a median time to cure exceeding 1 year. Combined topical and systemic antifungal treatments yield a higher chance of mycological cure than monotherapies. Advanced age, nail thickness and peripheral vascular disease are obstacle factors to cure.